Vertical Scar for a Skin-Only Tummy Tuck?

had a tummy tuck 2 weeks ago(skin-only) At post-op appt,I noticed that standing up I had a flat stomach with a little pooching around belly button, but what bothers me is when i bend over& sit down; I have a little roll on each side of my belly button. When I asked my surgeon he said some people's skin looses elasticity and re-strech in 48 hrs,especially w/ massive weight loss(185lbs). he said that he would have to do a vertical scar from tummy tuck line vertically to my breasts. why this?

Doctor Answers (6)

Loose skin above belly button after abdominoplasty

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You do have some options for this problem if it does not improve after 3 months (give it some time for the swelling to improve and skin to contract). It is common for patients who lost a large amount of weight to have the skin stretch out a bit after surgery. If you don't see improvement, the following options can be discussed with your Board Certified plastic surgeon:


• Repeat or circumferential abdominoplasty
• Vertical skin excision (as was recommended)
• Reverse abdominoplasty (skin being pulled up through an incision in the breast crease)
 


Columbus Plastic Surgeon
5.0 out of 5 stars 17 reviews

A Panniculectomy (Skin ONLY removal) is NOT a Tummy Tuck and will not produce Tummy Tuck Results

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Regarding: "Vertical Scar for a Skin-Only Tummy Tuck?

had a tummy tuck 2 weeks ago(skin-only) At post-op appt,I noticed that standing up I had a flat stomach with a little pooching around belly button, but what bothers me is when i bend over& sit down; I have a little roll on each side of my belly button. When I asked my surgeon he said some people's skin looses elasticity and re-strech in 48 hrs,especially w/ massive weight loss(185lbs). he said that he would have to do a vertical scar from tummy tuck line vertically to my breasts. why this
?"

A Skin only abdominal wall resection is called a PANNICULECTOMY or apron resection. It removed the overhand WITHOUT tightening the tummy muscles, without lifting the entire tummy skin up to the ribs to get off all skin excess and without upward movement of the belly button.

The average baby weighs close to 7 pounds and yet - by distending the womb from its normal lime size to that of a summer watermelon, it PERMANENTLY stretches the tummy muscles as well as splits the 6 pack (rectus) muscles. When you gained close to 200 pounds, a good portion of the fat was INSIDE the belly and was not all limited to fat under the skin. As a result, morbidly obese people have the same or worse stretching of the abdominal wall muscles as do pregnant women. To get pleasing results, they must be operated with similar muscle tightening techniques.

THE PROBLEM is that having a tight, flat tummy is NOT a medical NEED. It is a purely cosmetic need which insurance companies do NOT pay for. If you want the full "package" - a flat tummy, narrow waist, lifted Mons pubis etc - you must pay for it out of your pocket.

Since having a skin overhang is associated with a hard to clean area with bacterial overgrowth, rashes and sometimes ulcers, SOME insurance companies MAY pay for removal of this overhang with a PANNICULECTOMY. The operation is far simpler and shorter than a tummy tuck BUT patients often mistake it with a real tummy tuck. It is not and the much poorer results bear this out.

By the way, I have done hundreds of these operations and have NEVER encountered "some people's skin looses elasticity and re-stretch in 48 hrs". It is true that stretch mark damaged skin will stretch eventually but it never happens in 2 days. I suspect you had a limited operation and as a result have a limited result.

You MAY wish to obtain a second opinion with the operative note of your procedure. I would wait 6-8 months before having further surgery on this area to allow the inflammation to subside and skin return to normal.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Another operation after skin-only tummy tuck?

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Congratulations on your 185 lb. weight loss! If your photo is a post-op photo, you do indeed have residual skin laxity on either side of your belly button, and this will not get better as time goes by. I am struck by your statement that you had a "skin-only" tummy tuck; does this mean your doctor did a "smaller" procedure than a "standard" tummy tuck, which would involve transposition of the belly button, muscle tightening from breastbone to pubic bone, and removal of as much skin as possible dependent on the length of your horizontal incision? Perhaps you had an insurance-covered panniculectomy, which, as you now see, is inadequate to address the extensive skin excess caused by your fabulous weight loss.

So now you need the operation you should have had in the first place--likely a full circumferential beltlift (lower body lift, or torsoplasty), NOT a vertical skin-only excision to try to improve your present inadequate result! Please check your surgeon's credentials--is he or she certified by the American Board of Plastic Surgery?

Or is your doctor just "board-certified" in some other specialty? Realize that the "American Board of Cosmetic Surgery" is NOT an ABMS-recognized Board. The American Board of Plastic Surgery is the ONLY ABMS Board that certifies plastic surgeons. Other doctors that call themselves "Cosmetic surgeons" may be certified by other boards, such as the American Board of Dermatology, the American Board of Otolaryngology, the American Board of Surgery, the American Board of Obstetrics and Gynecology, or even the American Board of Family Practice. All of these are ABMS Boards, but these doctors have not completed full training in plastic and reconstructive surgery that qualifies them to take the American Board of Plastic Surgery Board Examinations. Of course, even fully-trained or American Board of Plastic Surgery-certified plastic surgeons can have less-than-perfect results or make less-than-ideal recommendations. But at least you have a good starting point, and it is certainly reasonable to be asking this question! Get answers you feel comfortable with or get another opinion! Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 106 reviews

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Skin laxity after tummy tuck

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With massive weight loss I often do what is called a fleur-de-lis approach imcorporating a vertical incision in some patients because as the weight comes down and you "deflate" it comes off in a verical and horizontal way, and a standard tummy tuck is often not enough.

Steven Wallach, MD
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Tummy tuck scars

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If this is a postop photo, you do have some extra skin still.  Patients with massive weight loss have extremely poor elasticity and sometimes it is necessary to have a full vertical scar also to take out as much as possible.  It will never be "tight" though!

Richard P. Rand, MD, FACS
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Persistent skin redundancy following tummy tuck for massive wieght loss.

+1

IT is very true that patients with massive weight loss, do not have good skin elasticity and have a greater tendency for recurrent skin laxity following body contouring procedures. Another alternative to performing a veritcal for upper abdominal laxity is to cosider a possible reverse abdominoplasty.

Otto Joseph Placik, MD
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.